1003425109 NPI number — FOUR OAKS HOME CARE SERVICES LLC- PART 1

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003425109 NPI number — FOUR OAKS HOME CARE SERVICES LLC- PART 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUR OAKS HOME CARE SERVICES LLC- PART 1
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FOUR OAKS HOME CARE SERVICES LLS -PART 1
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003425109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 SUMMIT AVE STE 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27405-7746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-491-8231
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W J J DR STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27406-4445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-491-8231
Provider Business Practice Location Address Fax Number:
877-895-1090
Provider Enumeration Date:
07/24/2020

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDS
Authorized Official First Name:
UCHENNA
Authorized Official Middle Name:
JUNIOR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-491-8231

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1003425109 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com